AFib Treatment Options

Restoring Your Heart’s Rhythm and Reducing Stroke Risk

At Emerald Coast Heart & AFib, our goal is to help you take back control of your heart rhythm and live life without the burden of atrial fibrillation (AFib).

The most effective treatment for AFib is Catheter Ablation, a minimally invasive procedure that has the highest success rates for restoring normal rhythm and preventing AFib recurrence.

However, AFib treatment is not one-size-fits-all—there are multiple options, from medications to procedures. Here’s how we determine the best approach:

Let’s dive into the best available treatment strategies so you can make an informed decision!

If your goal is to stop AFib at its source Catheter Ablation is the gold standard
If medications can help stabilize your rhythm Antiarrhythmic drugs
If controlling heart rate is the priority Rate control medications or pacemakers
If stroke prevention is necessary Blood thinners or Watchman LAAC

Rhythm Control: Getting Back to Normal Sinus Rhythm

For many patients, restoring and maintaining a normal heartbeat (sinus rhythm) is the primary goal. This can be achieved with:

Antiarrhythmic Medications: The First Step for Some Patients

Antiarrhythmic drugs help stabilize the heart’s electrical system and reduce AFib episodes. These medications work best in patients with occasional (paroxysmal) AFib and are less effective in long-standing cases.
Success rates for medications: ~35-65% after 1-2 years
Best suited for: Patients with mild AFib, younger individuals, or those not ready for or not a candidate for an ablation.

Important Note: While medications can help, AFib often returns despite drug therapy. That’s why Catheter Ablation is the most effective long-term solution for many patients.

Common Antiarrhythmic Drugs

Medication	Typical Dosage	Common Side Effects	1-2 Year Sinus Rhythm Success
Flecainide	50-150mg 2x/day (BID)	Dizziness, blurry vision, proarrhythmia	~40%
Propafenone	150-300mg 3x/day (TID)	Metallic taste, dizziness, nausea	~40%
Sotalol	80-160mg 2x/day (BID)	Fatigue, low blood pressure, QT prolongation	~40%
Dofetilide	250-500mcg 2x/day (BID)	QT prolongation (requires a 3-4 day hospital stay to initiate)	~50%
Dronedarone	400mg 2x/day (BID)	Nausea, liver enzyme changes, don’t use if heart failure	~35%
Amiodarone	200-400mg daily	Thyroid/lung/liver toxicity, tremors, neuropathy, sun sensitivity	~65%

Cardioversion: Resetting the Heart’s Rhythm

For some patients, a procedure called Cardioversion can be used to shock the heart back into normal rhythm using controlled electrical energy.

How Cardioversion Works:

You are sedated for comfort so you will not feel the shock.
Patches (electrodes) are placed on your chest.
A controlled electrical shock is delivered to restore sinus rhythm.

Why is a Transesophageal Echocardiogram (TEE) Needed?

If AFib has been present for more than 48 hours or duration is unknown, a TEE ultrasound is performed before cardioversion while sedated to rule out blood clots in the heart. This is for safety to minimize the risk of stroke.

Success Rate: ~95%, but AFib often returns without additional treatment (medications or ablation). Cardioversion resets your heart back to normal rhythm but does not address the underlying electrical issue which is why medications or ablation are often also necessary.

Catheter Ablation: The Most Effective Long-Term Solution

Catheter Ablation is the most successful way to treat AFib and achieve long-term normal rhythm. It is a minimally invasive, outpatient procedure that targets and eliminates the source of AFib using specialized energy.

How Does Catheter Ablation Work?

Conscious or usually general sedation is used for your comfort throughout the procedure.
Thin catheters are inserted into a vein in the leg (groin) and guided to the heart.
Using advanced 3D mapping, the pulmonary veins (where AFib originates) are identified.
Energy is delivered to create tiny lesions, blocking the abnormal signals that trigger AFib from entering the heart.
The procedure lasts 1-2 hours on average, and patients usually go home the same day (outpatient surgery)!

Success Rates: 80-85% success for first-time ablation; Up to >90% success with a second procedure if needed

Types of Ablation Energy Used:

Radiofrequency Ablation (RFA) – The Most Common & Well-Studied Approach

Uses heat energy to create precise lesions.
Effective for both paroxysmal and persistent AFib.
Often includes additional ablation areas if needed, a very versatile approach with very strong evidence in clinical trials.

Cryoablation – An Alternative Approach

Uses freezing technology instead of heat.
Slightly faster procedure but less adaptable for complex cases.

Pulsed Field Ablation – The Future of AFib Treatment

Uses non-thermal energy (electroporation) to selectively target only heart muscle cells.
Reduces risk of damage to surrounding structures (like the esophagus or phrenic nerve) but does have other risks such as hemolysis that Radiofrequency Ablation does not have.
Currently being studied as a potential breakthrough in AFib treatment (this is new, equivalent to other energy sources but not proven better yet)!

Key Takeaway: If you want the highest chance of staying AFib-free, Catheter Ablation is the best treatment available.

Rate Control: Keeping the Heart Rate Under Control

For patients who cannot maintain sinus rhythm, the next-best strategy is rate control—keeping the heart rate in a safe range so AFib is less symptomatic.

Medications for Rate Control

Beta Blockers (Metoprolol, Atenolol, Carvedilol)
Calcium Channel Blockers (Diltiazem, Verapamil)
Digoxin (less commonly used)

Goal: Keep resting heart rate under 100 bpm to minimize symptoms.

When is a Pacemaker + AV Node Ablation Needed?

If medications fail or are not tolerated, a pacemaker is implanted, and the AV node is ablated to completely block the AFib signals from controlling the heart rate. The pacemaker then controls the heart rate and the top chambers are still in AFib but can no longer cause the irregular beating and fast heart rates.

Stroke Risk Reduction: Preventing Blood Clots

AFib increases stroke risk, so treatment decisions are based on the CHA₂DS₂-VASc Score:

Risk Factor	Description	Pts
C	CHF/LV dysfunction	1
H	Hypertension	1
A2	Age ≥75	2
D	Diabetes	1
S2	Stroke/TIA/TE	2
V	Vascular disease	1
A	Age 65-74	1
Sc	Sex (female)	1

Score = 1 (Men) or 2 (Females), consider anticoagulation
Score ≥ 2 (Men) or ≥3 (Women), anticoagulation is recommended unless contraindicated
Higher total scores increase your risk of stroke each year

Blood Thinners Used for AFib:

Eliquis (Apixaban)
Xarelto (Rivaroxaban)
Pradaxa (Dabigatran)
Warfarin (requires INR monitoring)

Watchman Left Atrial Appendage Closure (LAAC)

For patients who cannot take blood thinners, the Watchman device seals off the area where clots form.

The Watchman is FDA-approved for patients with nonvalvular AFib who need an alternative to blood thinners. The Watchman device is as effective as blood thinners for reducing the risk of stroke without the lifelong bleeding risk of the strong blood thinners. 📌 For a detailed discussion on blood thinners & Watchman, see Watchman vs Blood Thinners.

Ready to Take Control of Your AFib?

Call us today to discuss your personalized AFib treatment plan! ❤️

850.854.3278 (85HEART)